154 Peewees Way (2)DAVIE COUNTY HEALTH DEPARTMENT
JHmer/Occupant (!qz0_Df9 � � c ✓f r
Address � �' �Q!C
Building Contractor
Gal. Manufacturer's Name
SEPTIC TANK PER,1IT Date
To:
Address
Address
Address
No. of lines Width in. Total length
Type of filter material
Total tons used
ft. No. sq. ft.
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Offic.
or his agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.